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目的研究His束起搏(HBP)的安全性和有效性以及对房室传导阻滞患者心功能的影响。方法入选53例有常规心脏起搏适应症合并各种程度房室传导阻滞及QRS期限<120 ms、左室射血分数(LVEF)>40%的患者,每位患者首选His束起搏,不成功者改用右室流出道间隔部起搏(RVSP组,41例),其中采用4.1F螺旋导线进行His束起搏成功者共12例(23%),在41例RVSP组患者中随机抽取12例作为对照组,所有患者均植入美敦力Adapta LADDR01起搏器,术后在观察期内关闭MVP功能、Search AV+。观察两组的心室导线参数及左室心功能变化;术后总共随访12个月。结果 HBP组的术后12个月感知及阈值、阻抗与术中比较差异无统计学意义[(3.52±1.14)vs.(3.63±1.16)m V;(1.79±0.62)vs.(1.49±0.4)V;(617.33±59.65)vs.(621.83±68.59)Ω;P>0.05];12例HBP组在随访中未发现心室失夺获现象;术后12个月时与RVSP组比较,HBP组LVEF明显偏高,左室后壁收缩延迟时间(SPWMD)明显减小,差异有统计学意义(P<0.05)。两组6 min步行试验(6MWT)差异无统计学意义(P>0.05)。结论 HBP的安全性和有效性与RVSP无差异;对于窄QRS波、LVEF>40%的房室传导阻滞患者的左室射血分数有保护作用、同时减少左室不同步。
Objective To investigate the safety and efficacy of His bundle pacing (HBP) and its effect on cardiac function in patients with atrioventricular block. Methods 53 patients with conventional cardiac pacing indications with various degrees of atrioventricular block and QRS duration <120 ms and LVEF> 40% were enrolled in this study. Each patient preferred His bundle pacing, In the RVSP group, 41 patients were unsuccessfully switched to right ventricular outflow tract septal pacing (12 cases, 23%). Of 41 RVSP patients, 41 All the patients were implanted with Medtronic Adapta LADDR01 pacemaker, and MVP function was turned off during the observation period. The changes of ventricular lead parameters and left ventricular function were observed in both groups. After a total follow-up of 12 months. Results There was no significant difference in perceived and threshold, impedance between the two groups at 12 months postoperatively in HBP group compared with those in HBP group [(3.52 ± 1.14) vs. (3.63 ± 1.16) m V; (1.79 ± 0.62) vs. (1.49 ± 0.4 ) V; (617.33 ± 59.65) vs. (621.83 ± 68.59) Ω; P> 0.05]. No ventricular seizure was found in 12 cases of HBP group. Compared with RVSP group at 12 months, HBP group LVEF was significantly higher, the left ventricular posterior wall contraction delay time (SPWMD) was significantly reduced, the difference was statistically significant (P <0.05). There was no significant difference in 6MWT between two groups (P> 0.05). Conclusions The safety and efficacy of HBP are not different from that of RVSP. For patients with narrow QRS complex, LVEF> 40% of patients with atrioventricular block have protective effect on LV ejection fraction and reduce left ventricular asynchrony.